O'Neill School of Public and Environmental Affairs
1315 E. Tenth St.
Bloomington, IN 47405
Institutional Affiliation: Indiana University
NBER Working Papers and Publications
|June 2019||Can Policy Affect Initiation of Addictive Substance Use? Evidence from Opioid Prescribing|
with Daniel W. Sacks, Thuy D. Nguyen, Kosali I. Simon: w25974
Drug control policy can have unintended consequences by pushing existing users to alternative, possibly more dangerous substances. Policies that target only new users may therefore be especially promising. Using commercial insurance claims data, we provide the first evidence on a set of new policies intended to reduce opioid initiation in the form of limits on initial prescription length. We also provide the first evidence on the impact of must-access prescription drug monitoring programs (MA-PDMPs), laws that do not target new users, on initial opioid use. Although initial limit policies reduce the average length of initial prescriptions, they do so primarily by raising the frequency of short prescriptions, resulting in increases in opioids dispensed to new users. In contrast, we find tha...
|February 2019||The Effect of Health Insurance on Mortality: Power Analysis and What We Can Learn from the Affordable Care Act Coverage Expansions|
with Bernard Black, Leticia Nunes, Kosali Simon: w25568
A large literature examines the effect of health insurance on mortality. We contribute by emphasizing two challenges in using the Affordable Care Act (ACA)’s quasi-experimental variation to study mortality. The first is non-parallel pretreatment trends. Rising mortality in Medicaid non-expansion relative to expansion states prior to Medicaid expansion makes it difficult to estimate the effect of insurance using difference-in-differences (DD). We use various DD, triple difference, age-discontinuity and synthetic control approaches, but are unable to satisfactorily address this concern. Our estimates are not statistically significant, but are imprecise enough to be consistent with both no effect and a large effect of insurance on amenable mortality over the first three post-ACA years. Thus, ...
|February 2017||Macroeconomic Conditions and Opioid Abuse|
with Christopher J. Ruhm, Kosali Simon: w23192
We examine how deaths and emergency department (ED) visits related to use of opioid analgesics (opioids) and other drugs vary with macroeconomic conditions. As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths. Our findings hold when performing a state-level analysis, rather than county-level; are primarily driven by adverse events among whites; and are stable across time periods.
Published: Alex Hollingsworth & Christopher J. Ruhm & Kosali Simon, 2017. "Macroeconomic conditions and opioid abuse," Journal of Health Economics, . citation courtesy of